HealthLeaders Media November 23, 2022
CMS finalized new procedures that will be subject to prior authorization in 2023.
KEY TAKEAWAYS
– CMS continues to cite the need to control unnecessary increases in volume as the deciding factor behind added prior authorizations each year.
– 93% of physicians reported to the American Medical Association that prior authorization led to delays of necessary care.
Earlier this year in the 2023 OPPS proposed rule, CMS brought forward a proposal to require prior authorization for an additional service category: facet joint injection procedures.
At the time, CMS said this would ensure Medicare beneficiaries receive medically necessary care while protecting the Medicare Trust Funds from unnecessary increases in volume by virtue of improper payments. This would happen without adding new...
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